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Posts Tagged ‘FRAX’

So how do you find out what aspects of your bone health are pretty good already, what will be easy to fix, and what will take some real work?  Start with a Complete Bone Health Evaluation.

DXA is about 1/3 of the story and should include both hips and spine.  When you are as old as I am, the spine probably is too arthritic to be really accurate, but helps complete the picture.  If you have had a total hip replacement, you should use the non-dominant forearm.

VFA will pick up many persons at increased fracture risk who are missed by DXA alone.  You should ask for VFA, especially if you or a parent have kyphosis (humpback) or have lost height.

The FRAX calculation picks up different individuals at high fracture risk.

Blood tests should include CBC, CMP, TSH, PTH, and 25-hydroxy Vitamin D as a start.  Further testing may be needed.

A medical history and examination focused on bone issues is a critical part of the full consultation.  We allot a minimum of 30 minutes for discussion.  Often a follow-up visit is needed to be sure both we and our patients are clear on the whole picture.

DXA alone misses over half of the individuals who need to improve their bone health.  Get a Complete Bone Health Evaluation.

Jay Ginther, MD

Adding VFA to DXA

January 9, 2017 @ 12:14 pm
posted by Dr Ginther

I have let the regular posts to the blog lapse for quite some time, while working on other issues.

I have been reviewing my first-time Vertebral Fracture Assessment (VFA) patients.  My latest research project included 1259 patients over 3 1/2 years.  I analyzed the patients by FRAX, height loss, age, and fragility fractures as well.  Nothing duplicated the findings by VFA.

I found that DXA alone missed many patients who have Clinical Osteoporosis if VFA (lateral spine) is taken into account.  I have presented this at ISCD and ASBMR.  Putting it into proper format to submit for publication took much more time than I anticipated.

This project is finished until I start the next sub-analysis.

I hope to get back to adding to the blog regularly.

Jay Ginther, MD

Diabetes + High BMD = Brittle Bone

August 11, 2015 @ 8:50 pm
posted by Dr Ginther

Patients with poorly controlled Diabetes and high blood sugar levels often have bone with above average Bone Mineral Density (BMD).  This is good?  WRONG !!

High blood sugars lead to glycolization of the Bone Matrix, which is the protein part of the bone – collagen.  This means that glucose (sugar) molecules are incorporated into the collagen protein chains.  This distorts and stiffens the Bone Matrix.

Normally, stiffer is better,  Calcium stiffens the bone matrix, which strengthens the bone.  But too much of a good thing is bad.  Too stiff becomes brittle.  Brittle bones break more easily than “stiff enough” bones.

Persons with diabetes who routinely run high blood sugars fracture more easily than non-diabetics.  Therefore, at the same BMD and T-score, diabetics have a higher Fracture Risk.

We knew that high blood sugars in diabetics are bad for kidneys, eyes and nerves.  Now we know that high blood sugars in diabetics are bad for bones too.

Take Control of Your Future.  If you have diabetes, work with your primary doc to get your blood sugars under control.

Jay Ginther, MD

Wisconsin “Bare Bones” 2015

June 7, 2015 @ 9:36 pm
posted by Dr Ginther

Friday, the University of Wisconsin “The Bare Bones of Osteoporosis Care” Symposium had a lot of practical information.  This included:

John Belizekian, MD summarized the latest research on  HyperParathyroidism.  While most of what we see is Secondary HyperParathyroidism, long term Secondary can morph into traditional Tertiary, or into a newly defined type of Primary HyperParathyroidism.

Joseph Shaker, MD explored new insights into Secondary Osteoporosis.  These are separate medical conditions which cause osteoporosis and must be addressed if we are to succeed in treating the resulting osteoporosis.

Fergus McKiernan discussed the success of Vertebroplasty and Kyphoplasty – if you choose patients with the right Vertebral Fracture problems to operate on.

Niel Binkley, MD explored Medication Risks in comparison to the Fracture Risks for women and men when NOT taking medications.

Dr Belizekian discussed new therapies which avoid the problems of current medications.  Odanocatib, Abaloparatide, and Rososumab are all in FDA phase 3 trials and could be available within 5 years.  FRAX can now incorporate TBS (Trabecular Bone Score).

I will cover these topics, along with those discussed at NOF, over the next few weeks.

Jay Ginther, MD